Intestinal Rotation, Malrotation, Volvulus Explained
Vložit
- čas přidán 2. 06. 2024
- What is volvulus? What is intestinal malrotation?
What is normal intestinal rotation? Nonrotation? Reversed rotation?
This video will help you understand all of these as well as volvulus, a life threatening diagnosis...just the word volvulus is enough to get any surgeon's attention!
Sign up and join the CITIZENSURGEON Community: citizensurgeon.co/signup
MUST HAVE SURGERY BOOKS
Moore's Clinically Oriented Anatomy citizensurgeon.co/Moore
Netter's Anatomical Atlas citizensurgeon.co/Netter
Schwartz Principles of Surgery citizensurgeon.co/Schwartz
Fischer's Mastery of Surgery citizensurgeon.co/Mastery
Zollinger's Atlas of Surgical Operations citizensurgeon.co/Zollinger
Top Knife (MUST MUST HAVE) citizensurgeon.co/topknife
PICK UP THE BIBLE OF PEDIATRIC SURGERY
Holcomb and Ashcraft's Pediatric Surgery citizensurgeon.co/Ashcraft
Intestinal rotation is a difficult topic to understand in anatomy and embryology. It's a very important topic to understand because of the implications if intestinal rotation does proceed correctly.
In this video I'm going to make it easy and straightforward for you! I'm even going to put on a funny looking anatomy apron to help illustrate everything!
Malrotation volvulus is a life threatening problem and a critical topic in surgery.
How do you evaluate the child with bilious emesis and what should you be most worried about?
In addition to malrotation volvulus there is a spectrum of rotational abnormalities including non rotation, reversed rotation, paraduodenal hernia and malrotation without volvulus that can be difficult to understand.
Today I'm going to take you through a clinical case of a 5 week old with bilious emesis and we're going to understand the following critical topics:
1.). What is malrotation with volvulus and when should I be concerned?
2.). What does normal intestinal rotation look like?
3.). What are the intestinal rotation abnormalities?
4.). How do I workup malrotation volvulus and the intestinal rotation abnormalities?
5.). How do I interpret an upper gastrointestinal contrast study in these patients?
6.). How can ultrasound be helpful in patients with malrotation?
7.). How do I treat malrotation volvulus and IRA?
8.). What is a Ladds procedure?
This is a lot of information for sure but I'm confident that this talk will help you in your studies to understand a critically important topic!
Sign up for the Saturday Six Newsletter and get the six things that have had me thinking, inspired by or curious about every week!
Sign up: citizensurgeon.co/saturdaysix
We're going to cover a few clinical cases as well and at the bottom of the description I'll put the answers so you can check yourself!
Check out these AMAZING timestamps and fast forward if you need to:
Start 00:00
Clinical Case of Malrotation Volvulus 01:21
Epidemiology of Malrotation 03:27
What is normal intestinal rotation? 05:11
What is Malrotation? 07:20
Classifying Intestinal Rotation Anomalies 08:40
Symptoms of Malrotation? 13:04
Workup of Intestinal Rotation Anomalies 14:05
Treatment of Intestinal Rotation Anomalies? 18:54
REFERENCES
citizensurgeon.co/Malrotation...
citizensurgeon.co/Malrotation...
Chapter 31 Holcomb and Ashcraft's Pediatric Surgery citizensurgeon.co/Ashcraft
SOME RECENT READS
The Miracle Morning by Hal Elrod - citizensurgeon.co/MiracleMorning
Atomic Habits by James Clear - citizensurgeon.co/AtomicHabits
BE MY FRIEND
Sign up and join the CITIZENSURGEON Community: citizensurgeon.co/signup
My Website: www.citizensurgeon.com
Instagram: citizensurgeon.co/instagram
Twitter: citizensurgeon.co/twitter
Koji: citizensurgeon.co/Koji
WHO AM I?
I'm Dr. Erik Pearson, FACS and I am a board certified pediatric surgeon living in Las Vegas. I make surgical education videos on all topics in general surgery as well as talks on lifestyle design as a surgeon, book reviews, and studying effectively. I also write a weekly newsletter called the Saturday Six where I identify Six different discoveries of the week. You can get the weekly newsletter by signing up to the CITIZENSURGEON Community!
DISCLAIMER
While my aim is to help educate you for the ward, the surgical ICU, the operating room and your exams remember these videos are not a replacement for your reading, your medical school and residency preparation and most important your own decision making. If you have medical questions definitely consult a medical professional. Good luck and enjoy!
Affiliate Links - There are a few links in the description that may lead to a kickback to me to help support the channel.
![[柴犬ASMR]曼玉Manyu&小白Bai 毛发护理Spa asmr](http://i.ytimg.com/vi/0TsXQ7z2Dh4/mqdefault.jpg)
My son was born and had LADDS procedure at less then 24 hours old due to malrotation volvulus. Unfortunately 6 months later it reoccured and he ended up losing all but 13cm of small intestine and is now TPN dependent.
Really interesting video that breaks everything down so well. I hope it raises more awareness as many medical professionals we've come across before aren't always fully aware
From my daughter. Diagnosed at 31 years old, had the Ladd’s procedure then: Nice to know “why” but the idiots surely didn’t do me any favors in missing it all of those years…. In reading the comments on his CZcams, he doesn’t have suggestions for adults besides the Ladds- which clearly is not correct. We need him to do some research and create one of these for those of us that the medical system failed, he could call it the “the after math of ignorance- what to do with an adult that HAS been diagnosed but is screwed up from misdiagnosis”
My 17 year old son had malrotation with volvulus and the Ladd's procedure performed 3 days ago. I am typing this as I sit next to his hospital bed. I have a background in healthcare, specifically radiology and sonography. This video made it easier for me to understand and also will help me explain his problem to friends and family. He was diagnosed with gastroparesis as a child but now we believe this was the problem the whole time. I feel like he has been dodging the volvulus bullet his whole life!! Thank you again for helping me understand the problem and the procedure to fix it.
Thank you for such a thoughtful message and I hope your son recovers quickly from his surgery! I’m glad I could help make a difficult problem a little easier to understand and very happy he never suffered from volvulus…while the vast majority happen in the first year of life it can happen after that time.
My mom went to urgent care on Monday March 13 2023 because she was having diarrhea and pain in her stomach they did a CT scan and found she had a small bowel malrotation and fluid in the stomach they said you need to go to the emergency room right now and we did but they sent her home Thursday saying she has the stomach flu she is still in sever pain unable to pass gas or eat and her stomach is bloated and she says it feels like a tight basket ball they never rescanned her in the hospital she's taking the house doctor word over urgent care by the house doctor saying it's the flu why would urgent care say she had that if it wasn't true I'm unable to convince her to go to a different hospital for a second opinion who's right here the hospital or urgent care she's in terrible pain and unable to have a bowel movement now and she said it feels like her chest is full of fluid and just in pain.
Whenever I can't understand a surgical topic, your videos make it super easy! Thank you!
Thanks so much Karla!
My now 8 year old daughter had to have emergency surgery for malrotation and volvulus. It was discovered when she was 1 week old. Unfortunately I had expressed concern for the first week of life - she was lethargic and vomiting, but not after every feed. Her vomit was yellow and turning greener by the day. Unfortunately I had a couple doctors tell me it was her jaundice coming out in vomit, and that she had reflux. Thank god a peds nurse took my gut feeling seriously and insisted on a scan with contrast sooner than later. Her bowel pinked up, she had the ladds procedure and appendectomy. Surgeon told us she was so full of bile that she had a matter of a couple hours before she wouldn’t have survived. I asked two questions - when did this happen? They said 7-12 weeks gestation, like you explained OR during a traumatic delivery, which I don’t think I had with her. I had a level 2 ultrasound at 20 weeks due to my history of a heart defect, and this was not detected at 20 weeks. So had it not happened yet, or is it not easy to spot at 20 weeks when they’re looking at the heart? Would you say there are any other long term risk of side effects from this, other than surgical scar tissue issues? I still get extra nervous when she gets stomachaches!
Your video is amazing and so educational…and it needs to be heard by many healthcare professionals! I’ve been a nurse for 17 years, and until my 3.5 year old was diagnosed at two weeks of life, I had never heard of Intestinal Malrotation. If it wasn’t for the radiologist that explained to me exactly what she was seeing in real time during his upper GI study and let me watch with her, I wouldn’t have known to advocate for him the next morning when the head of pediatric surgery wanted to discharge him home with a diagnosis of reflux. After we spoke up, she later admitted that they failed to watch the fluoroscopy video, but instead just looked at the still images. She repeated his upper GI study and he was in the OR having emergency Ladd’s two hours after we would have been discharged. Sadly I have found that this dismissal attitude for many who suffer with Malrotation is all too common. 😢. Thank you for raising awareness!!! 🙌🙌
Also, at 21:46 you start to say that the risk later in life in relationship to a narrow mesentery…but I’m not sure you explained further what your thoughts were about this. What would the risk be?
I’m sorry you had that experience with your son and I hope everything went well with the Ladds! Malrotation can fly under the radar and if it’s missed it can be devastating as you are aware! Thanks for your support!
In malrotation the mesentery is narrow, not broad like it should be and one of the goals of a Ladd operation is to widen it, but it will never be normal so there is always a risk of recurrent Volvulus even if that risk is low
Amazing Dr. Erik, so well put together
Thanks so much for the feedback! Glad you enjoyed it!!!! What topic do you want to learn about?
VERY helpful for surgery shelf, thank you for making this very detailed and high yield and easy to understand
Awesome! You are welcome, what other topics do you want to learn about
An amazing video it helped me much in understanding the topic
What a wonderful video. Very educational and in depth. I love this. 💫
Thanks so much I appreciate that! Glad it was helpful!
Thank you so much Dr, Erik
Absolutely!Glad you enjoyed it’
Excellent Thank you
Absolutely so happy you enjoyed it!
Great video Doctor, loved how you used a 3D model for the explanation. PGY-1 learning from you right here!
Dr. Bueno thanks so much! Glad you found it useful! Intestinal rotation can be a bit confusing so I put on the apron :)
That's was so simple explanation l like it very much thanks 👍
Thanks so much for the feedback!!
I am 69 years old and my small intestine twisted! The pain was excruciating! Lucky to be alive with eight hour wait time…waiting for ambulance three hours to take me to Calgary, one hour trip….then four in Calgary, before they did surgery! Lost 126cm of small bowel total with two surgeries for resection! Induced coma for about 20 hours to see how much more died! Doctors and nurses were amazing and five days in ICU…very sick! Canada’s healthcare system is bad! I should have had emergency surgery ASAP….won’t happen here!! It was a Miracle actually to still be here and so thankful!
Very happy to hear you are ok! This is one of those definite surgical emergencies!
@@citizensurgeon it’s hard to believe how sick I was and got to live! Eight hour wait, but I am so grateful it did not perforate! Keep healthy Doc and stay safe!!!
Great🙂
Excellent, glad you enjoyed it!
Love the apron! What always confused me was books or surgeons would say clockwise and counter clockwise without specifying from what perspective! (From patients perspective? Surgeons perspective?)
I’m so pumped that you found that helpful, normal rotation As I tried to describe his counter clockwise from surgeon perspective and clockwise from the patient’s perspective
I have a malrotation of my small intestine. So my appendix is on my left side
Thank you for posting this. My 7 week old daughter had Malrotation with Volvulus. We took her to A&E and they treated her for a urine infection despite her throwing up Green bile. By the time she received the medical attention which she needed it was to late as she had total intestinal loss and lost her fight.
I’m so sorry for your loss.
Oh Sarah, I’m so sorry, my heart aches for you and your family
@@citizensurgeon it’s is very frustrating that 18 years on and still some if the medical profession don’t know much about this and how serious it can be. Keep doing what you’re doing
❤
my daughter had undergone the surgery at 4days old. now she is 2yrs old. if there's any chance the malrotation can be repeated?
Thank you for the question, unfortunately even after a Ladd’s operation for malrotation there is a risk of volvulus. If your child is having any trouble definitely seek out your doctor.
Dr Erik , I been suffering from this pain in my abdominal it started with something t try rotating in my lower right stomach.
After my stomach felt icy cold and blotted felt it’s going to pop.
Been week they done blood test nothing comes .only thing that keep coming back it’s blood in urin.
They done scan nothing. They have not clue what’s going on. And am still in extreme pain.
Any advice plz
Khizra, I'm sorry you're having pain, unfortunately I can't give medical advice but I hope you've found a doctor or medical provider that can help!
I was born with a large Omphalocele. I have a midgut malrotation. I was born in 1977. They didn't know until I was born.
Doctor I want your suggestion as from approx 2 months i am having abdominal pain I had a ultrasound and 3d city scan reports came out that by birth only I have my small intestine in place of large intestine and large intestine in place of small intestine before these 2 month I had no problem is it necessary to operate?
Hi Nikita, I'm sorry I can't provide any specific opinion as a need for operating depends on many different things, definitely have a conversation with your doctor. Good luck. Apologies for such a delayed reply!
Any suggestions where to buy that apron? 😁🤭❤.. With your signature
Haha! Amazon! With my signature…perhaps I could do a giveaway :)
Malrotation... perfectly healthy happy10 week old baby. Surgery or not? No volvulos. Pediatric GI specialist says it's 50 50 doing surgery is ok and not doing surgery is ok. Then monitor on the extra cautious side. Medical opinion?
Stacie, thanks for engaging and I'm sorry for the delayed reply. I can't give you my opinion on this specific baby but can agree that there is significant discussion about this in our community. Symptomatic children who have feeding difficulties and evidence of malrotation certainly get a Ladd's procedure, laparoscopic or open. Children who are asymptomatic can get a Ladd's procedure but have also been safely observed though this is certainly after a discussion with he medical and surgical team. Here are a few references to look over.
pubmed.ncbi.nlm.nih.gov/26205079/
pubmed.ncbi.nlm.nih.gov/35305800/
Can’t comment on the content for obvious reasons but you present these so well! Looks like you are a born teacher as well as a surgeon! Here is probably a stupid question. When a surgeon makes an incision in a patient, why doesn’t the patient lose massive amounts of blood or bleed to death?
Thanks Nora! Great question, there are a few things Going on and I made a video on hemostasis and talked about this a bit. I assure you patients bleed but as a surgeon I’ll use tools like bovie electrocautery or a harmonic scalpel to divide tissues with less blood loss. The body reacts to injury by sending platelets which deposit fibrin with clotting cascades and eventual clot and repair. It’s truly amazing.
Really appreciate your feedback on the teaching :) I do love it and love connecting with people all over the world! Heading up to Canada at the end of the month to hike in Banff!
@@citizensurgeon Thanks! Will look some of this up!
@@citizensurgeon I looked up the harmonic scalpel and the electrocautery. The advances that have been made in the equipment that is available and combined with the surgeon’s skill and the body’s ability to repair itself are truly amazing! One has to wonder how the surgeons in the past did what did with limited resources.
I need your advice.. My child does not have any symptoms other than a slight flatulence;
his age 3 Months and he does not defecate except using glycerin
X-rays read as follows:
BA-ENEMA:
Control film shows no evidence of opaque lesions in abdominal cavity.
Malrotated left & RT colon
Transverse is normal.
Rectal ampoule shows normal lumen & mucosa
No evidence of distal narrowing or tapering segment
Delay evacuation is noticed.
_IMPREESION:_
*Mal-rotation of the bowel with hypotonic colon*
Can I send you the image file PDF
Please advise me, I haven't taken any action and am very confused
Hi there, my apologies for the delayed reply, I can't give any medical advice but I hope you find some clarity in talking with your physician. Good luck and I hope you find answers.
@@citizensurgeon
Alhamdulillah, my son is now defecating normally without any medical intervention؛
To this day, I don't know exactly what hit him
Thank you for your response to the case..
Sir my child also had operation when he was 2 days old .His appendix is removed .small intestine on right side and large intestine in left .Now he is good .But in future any problem will occur or he will live healthy life .pls reply .
While I can't give an answer specific to your son, after a Ladd's operation the vast majority of children lead healthy unrestricted life! Have a wonderful life!
Thank u sir
Sir my son also had diarrhea 2 months back but now he is 19 months old and today he defecated the same food which he ate in the morning and it was the same food what he ate in morning like from mouth what he ate he defecate the same what is the cause of this what to do
I have had surgery when I was three days old for malrotation volvulus as I was extremely unwell. I’m now 25 went for barium recently as I was unwell and docs said malrotation do they not fix it in the surgery and place it back to normal like how regular people have it . Or is this something they cannot rectify
Unforuntately we can't place is back like normal what we do is a Ladd's procedure where we put the bowel back into a position of "nonrotation" where the duodenum goes straight from left to right and the small bowel follows on the right with the colon placed on the left. This is "nonrotation" or "Ladd's position". Normal bowel has a duodenal c loop that is retroperitoneal and an ascending and descending colon that are also retroperitoneal and fixed. Does that make sense?
@@citizensurgeon yes that makes sense thank you for the explanation
Hello.dr , I hope you can help me
i had a question . my son was born with intestine malrotation , he underwent surgery when he was 2 days old and he underwent surgery for the second time when he was 8 months old . i know he probably got it again many times.
can dr stop intestine malrotation from happening again. can dr fix intestine malrotation like normal people ?
Hi Paul,
While I can't give an answer specific to your son I can give you a broad answer.
When children with intestinal malrotation are symptomatic, either from intolerance of feeding, pain or volvulus the operation that is done is the Ladd's procedure. I explain this procedure in the video and the purpose of the procedure is to "unwind" the intestine, divide the Ladd's bands that could be causing duodenal obstruction, widen the mesentery so that it has a decreased likelihood of revolvulizing or "retwisting" and placing the intestine in a position of non rotation or "Ladd's position". In this position the duodenum is straightened out from the pylorus of the stomach on the patients right side and the small bowel follows, the large intestine is placed on the left and traditionally the appendix is removed because of this mirror positioning.
The important point...the surgery for malrotation does not put the intestine back into normal position with a traditional duodenal C loop and a fixed right colon on the right. None of the intestine is fixed to the retroperitoneum. Recurrent volvulus is unlikely but it can happen if the vascular pedicle (blood supply to the intestine) is narrow.
I hope this helps and I wish you and your son the best.
How is your son now ?